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Donor-Transmitted Cancer in Orthotopic Solid Organ Transplant Recipients: A Systematic Review

George H B Greenhall1,2, Maria Ibrahim1,2, Utkarsh Dutta3

  • 1Department of Statistics and Clinical Research, NHS Blood and Transplant, Bristol, United Kingdom.

Transplant International : Official Journal of the European Society for Organ Transplantation
|February 21, 2022
PubMed

Insights

Donor-transmitted cancer (DTC) in orthotopic organ recipients has a poor prognosis, with high mortality and limited treatment options. Re-transplantation offers a chance for cure, but tumor recurrence remains a concern.

Area of Science:

  • Transplantation immunology
  • Oncology
  • Medical ethics

Background:

  • Donor-transmitted cancer (DTC) poses significant risks to transplant recipients.
  • Orthotopic solid organ transplant recipients (SOTRs) face limited treatment options for DTC compared to heterotopic recipients.

Purpose of the Study:

  • To systematically review the evidence on DTC in orthotopic SOTRs.
  • To analyze presentation, diagnosis time, cancer extent, management, and survival outcomes for DTC in SOTRs.

Main Methods:

  • Systematic literature search of multiple databases (MEDLINE, EMBASE, PubMed, Scopus, Web of Science) in January 2020.
  • Inclusion of reported outcome cases, exclusion of donor-derived cancers, and quality assessment using established checklists.
  • Data extraction focused on presentation, time to diagnosis, cancer extent, management strategies, and patient survival.

Main Results:

  • Analysis of 73 DTC cases across liver, heart, and lung transplant recipients from 58 publications.
  • Median time to diagnosis was 8 months, with 42% diagnosed at widespread disease stage.
  • High mortality (75%) and poor median survival (7 months); re-transplantation in 13 cases resulted in recurrence in 3.
  • Worst survival observed in transmitted melanoma and central nervous system tumors.

Conclusions:

  • DTC in orthotopic SOTRs has a grave prognosis, characterized by high mortality and limited survival.
  • While re-transplantation is the most promising curative approach, tumor recurrence is a significant risk.
  • Clinical heterogeneity and publication bias necessitate careful interpretation and suggest refinements in clinical practice for managing DTC in SOTRs.
Keywords:
cancerdeceased organ donorsdonor-transmitted diseaseheart transplantationliver transplantationlung transplantation

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